摘要
目的:探讨如何正确看待和运用病理学专家会诊结果。方法:收集专家会诊病理诊断2800例,其中2400例由上级1家医院专家会诊,400例由2—4家医院专家会诊。将2400例上级医院专家会诊结果与我院初步诊断结果进行比较,将400例由多家医院专家诊断的结果进行对比分析。结果:经上级1家医院专家会诊2400例中,我院诊断明确(Ⅰ类)260例(10.83%),疑难诊断(Ⅱ类)2008例(83.67%),描述性诊断(Ⅲ类)110例(4.58%),无法诊断(Ⅳ类)22例(0.92%);会诊诊断明确(Ⅰ类)1581例(65.88%),疑难诊断(Ⅱ类)692例(28.83%),描述性诊断(Ⅲ类)109例(4.54%),无法诊断(Ⅳ类)18例(0.75%)。专家会诊后疑难诊断率显著下降,与原诊断相比差异显著(P〈0.01);描述性诊断和无法诊断率与原诊断相比无明显差异(P〉0.05)。经多家医院会诊400例中专家诊断一致或相近204例(51.00%),定性一致分类不同193例(48.25%),良恶意见相反3例(0.75%),其中病例1经随访一专家会诊意见与随访结果不符。结论:专家会诊使较多疑难病理诊断得以明确,但疾病具有复杂性,不同专家会诊结果有分歧;仍有部分疑难病理诊断需要随访病人才能得到确诊;制作优质的组织蜡块和切片,加强临床医生、主检病理医师及病理会诊专家三者之间沟通,并对患者长期随访是获得正确结果的最好方法。
Objective :To search how to hold a right attitude for junior physician to the expert's opinion and how to rightly use these results in clinical practice. Methods :2 800 patients'paraffin wax embedded tissue sections which had been examined by pathological specialists (experts) were retrospectively analysed. 2 400 patients'pathologieal diagnosis resting on one expert and 400 patients 'pathological diagnosis resting on 2 to 4 experts were compared to the initial diagnosis made by thejunior pathological physician. Results:In the diagnosis of 2 400 patients made by junior physician, Definite diagnosis was made in 260 patients (10.83%) , Indefinite diagnosis in 2 008 patients ( 83.67% ) , Descriptive diagnosis in 110 patients (4. 58% ), No diagnosis in 22 patients (0. 92% ). After consulted experts, Definite diagnosis was made in 1 581 patients (65.88%) ,Indefinite diagnosis in 692 patients (28. 83% ) ,Descriptive diagnosis in 109 patients (4. 54% ) ,No diagnosis in 18 patients (0. 75% ) ,there was a significant difference in number of indefinite diagnosis between the junior doctor and expert ( P 〈 0. 01 ) ,the number of indefinite diagnosis was deceased in expert group, there were no significant differences (P 〉 0. 05) in number of descriptive diagnosis and no diagnosis between the two groups. In 400 pateints, after consulted 2 - 4 experts,204 patientspathologieal diagnosises were consistent or similar (51.00%), 193 patients' diagnosises were different in classification of the lesion (48.25%) ,there was contrary opinions in 3 patients" diagnosises, malign or benign(0.75% ). Conclusion : Pathological specialists" consultation can increase the accuracy of the diagnosis, but the results consulted different experts are not all the same, some suspicious pathology diagnosis cant be definite without a long term follow up. The right diagnosis is based on a high quality tissue sections, patient's long-term follow up and enhancing communication among clinic physician, pathological physician and expert.
出处
《临床误诊误治》
2006年第9期85-87,共3页
Clinical Misdiagnosis & Mistherapy
关键词
病理讨论
转诊和会诊
专家委员会
诊断
Pathological conference
Consultation
Experts committee
Diagnosis